Summer Camp Application

Student Information

Child's Full Name*

First Middle Last

Child's Preferred Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Birthdate*

Age

Please enter a number from 0 to 10.

Gender

Guardian 1 Information

Name*

First Last

Is address different than child's?

Yes, it's different

No, it's the same

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone*

Preferred Email*

Occupation

Business Name

Guardian 2 Information

Name

First Last

Is address different than child's?

Yes, it's different

No, it's the same

Current Address

If different from child's address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone

Preferred Email

Occupation

Business Name

Medical Information

Pediatrician's Name

First Last

Phone

Allergies

Special Health Needs

Emergency Contact #1

Name

First Last

Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact #2

Name

First Last

Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about Christopher Academy?

Other Source

Additional Child Information

Indicate any other information you would like us to know about your family or child in the box above

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

Apply Online

Student Information

Guardian 1 Information

Guardian 2 Information

Medical Information

Emergency Contact #1

Emergency Contact #2

Session Choices

Have Questions?

Ready to Apply?

Come See Us

Christopher Academy

Support

Contact Us